| NPI | 1699876854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: AK MD2316) |
| Additional Taxonomies | 208800000X Urology (Licence: WA MD00025207) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-03-03 |